1
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Almonacid-Sánchez C, Cosío BG, Trisán-Alonso A, Callejas-González FJ, Cisneros C, Martínez-Moragón E, Plaza Moral V, Vera E, Soto-Campos JG, Martínez-Rivera C, Alcazar-Navarrete B, Urrutia Landa I, García-Rivero JL, Padilla Galo A, Álvarez-Gutierrez F, Ramos-González J, Carretero-Gracia JÁ, Lluch I, Puente L, Andujar-Espinosa R, Pérez-de-Llano L. Therapeutic Goals and Treatable Traits: Long-Term Trends in a Severe Asthma Population. Arch Bronconeumol 2023; 59:842-845. [PMID: 37865605 DOI: 10.1016/j.arbres.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 10/23/2023]
Affiliation(s)
| | - Borja G Cosío
- Hospital Universitario Son Espases-IdISBa-CIBERES, Palma de Mallorca, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Luis Puente
- Hospital General Universitario Gregorio Marañón, Facultad de Medicina Complutense de Madrid, Madrid, Spain
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2
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Mümmler C, Milger K. Biologics for severe asthma and beyond. Pharmacol Ther 2023; 252:108551. [PMID: 37907197 DOI: 10.1016/j.pharmthera.2023.108551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/15/2023] [Accepted: 10/23/2023] [Indexed: 11/02/2023]
Abstract
Advances in pathophysiological understanding and the elucidation of a type 2 inflammatory signature with interleukins 4, 5 and 13 at its center have led to the development of targeted antibody therapies that are now approved for the treatment of severe asthma. In suitable patients, these medications reduce asthma exacerbations and the necessity for oral corticosteroids, improve asthma control, quality of life and lung function. A proportion of patients with severe asthma may even achieve remission under ongoing biologic therapy. Type-2 inflammatory comorbidities are frequent in patients with severe asthma, sharing overlapping pathophysiology and may similarly respond to biologic treatment. Here, we give an overview of the six biologic therapies currently approved for severe asthma and review randomized clinical trials and real-life studies in asthma and other type-2 inflammatory diseases. We also discuss selection of biologics according to licensing criteria, asthma phenotype and biomarkers, monitoring of treatment response and proceedings in case of insufficient outcome under therapy.
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Affiliation(s)
- Carlo Mümmler
- Department of Medicine V, LMU University Hospital, LMU Munich, Germany; Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Katrin Milger
- Department of Medicine V, LMU University Hospital, LMU Munich, Germany; Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany.
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3
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Bagnasco D, Savarino EV, Yacoub MR, Braido F, Candeliere MG, Giannini E, Passalacqua G, Marabotto E. Personalized and Precision Medicine in Asthma and Eosinophilic Esophagitis: The Role of T2 Target Therapy. Pharmaceutics 2023; 15:2359. [PMID: 37765327 PMCID: PMC10536373 DOI: 10.3390/pharmaceutics15092359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/06/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
The role of type 2 inflammation has been progressively associated with many diseases, including severe asthma, atopic dermatitis, nasal polyposis, eosinophilic granulomatosis with polyangiitis, and, recently, eosinophilic esophagitis. Despite this, the association between asthma and esophagitis is still poorly known, and this is probably because of the low prevalence of each disease and the even lower association between them. Nonetheless, observations in clinical trials and, subsequently, in real life, have allowed researchers to observe how drugs acting on type 2 inflammation, initially developed and marketed for severe asthma, could be effective also in treating eosinophilic esophagitis. For this reason, clinical trials specifically designed for the use of drugs targeted to type 2 inflammation were also developed for eosinophilic esophagitis. The results of clinical trials are presently promising and envisage the use of biologicals that are also likely to be employed in the field of gastroenterology in the near future. This review focuses on the use of biologicals for type 2 inflammation in cases of combined severe asthma and eosinophilic esophagitis.
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Affiliation(s)
- Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinic San Martino, University of Genoa, 16132 Genoa, Italy
- Department of Internal Medicine (DIMI), University of Genoa, 16132 Genoa, Italy
| | - Edoardo Vincenzo Savarino
- Department of Surgical Oncological and Gastroenterological Sciences, University Hospital of Padova, 35145 Padua, Italy
| | - Mona-Rita Yacoub
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Hospital San Raffaele, 20132 Milan, Italy
- Faculty of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Fulvio Braido
- Allergy and Respiratory Diseases, IRCCS Policlinic San Martino, University of Genoa, 16132 Genoa, Italy
- Department of Internal Medicine (DIMI), University of Genoa, 16132 Genoa, Italy
| | - Maria Giulia Candeliere
- Allergy and Respiratory Diseases, IRCCS Policlinic San Martino, University of Genoa, 16132 Genoa, Italy
- Department of Internal Medicine (DIMI), University of Genoa, 16132 Genoa, Italy
| | - Edoardo Giannini
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genova, 16132 Genova, Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinic San Martino, University of Genoa, 16132 Genoa, Italy
- Department of Internal Medicine (DIMI), University of Genoa, 16132 Genoa, Italy
| | - Elisa Marabotto
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genova, 16132 Genova, Italy
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4
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Milger K, Suhling H, Skowasch D, Holtdirk A, Kneidinger N, Behr J, Timmermann H, Schulz C, Schmidt O, Ehmann R, Hamelmann E, Idzko M, Taube C, Lommatzsch M, Buhl R, Korn S. Response to Biologics and Clinical Remission in the Adult German Asthma Net Severe Asthma Registry Cohort. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2701-2712.e2. [PMID: 37301433 DOI: 10.1016/j.jaip.2023.05.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/12/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Recently, criteria for evaluation of response to biologics have been proposed and the concept of clinical remission has gained attention as a possible goal even in severe asthma. OBJECTIVE To analyze the response and remission in the German Asthma Net severe asthma registry cohort. METHODS We included adults not using a biologic at baseline (V0) and compared patients treated between V0 and 1-year visit (V1) without using a biologic (group A) to patients starting with a biologic after V0 and continuing it up to V1 (group B). We applied the Biologics Asthma Response Score to quantify composite response in good, intermediate, or insufficient. We defined clinical remission (R) as absence of significant symptoms (Asthma Control Test score ≥ 20 at V1) in the absence of exacerbations and oral corticosteroid therapy. RESULTS Group A included 233 and group B 210 patients, the latter receiving omalizumab (n = 33), mepolizumab (n = 40), benralizumab (n = 81), reslizumab (n = 1), or dupilumab (n = 56). At baseline, group B had less often an allergic phenotype (35.2% vs 41.6%), lower Asthma Control Test score (median, 12 vs 14), more exacerbations in the past year (median, 3 vs 2), and more often high-dose inhaled corticosteroid treatment (71.4% vs 51.5%) than group A. After 1 year of treatment, rates of response (good: 61.4% vs 34.8%; intermediate: 26.7% vs 42.9%; insufficient: 11.9% vs. 22.3%) and/or clinical remission (37.6% vs 17.2%) were higher in group B than in group A. CONCLUSIONS Despite more severe asthma at baseline, patients treated with biologics had a markedly higher probability of achieving good clinical response and/or remission than patients treated without biologics.
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Affiliation(s)
- Katrin Milger
- Department of Medicine V, University Hospital, LMU Munich, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany.
| | - Hendrik Suhling
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Dirk Skowasch
- Department of Internal Medicine II - Pneumology/Cardiology, University Hospital Bonn, Bonn, Germany
| | | | - Nikolaus Kneidinger
- Department of Medicine V, University Hospital, LMU Munich, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Jürgen Behr
- Department of Medicine V, University Hospital, LMU Munich, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | | | - Christian Schulz
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Olaf Schmidt
- Pneumologische Gemeinschaftspraxis Koblenz, Koblenz, Germany
| | | | - Eckard Hamelmann
- Children's Center Bethel, University Hospital Bielefeld, Bielefeld, Germany
| | - Marco Idzko
- Department of Pulmonary Medicine, Medical University of Vienna, Vienna, Austria
| | - Christian Taube
- Department of Pulmonary Medicine, University Hospital - Ruhrlandklinik, Essen, Germany
| | - Marek Lommatzsch
- Department of Pneumology and Critical Care Medicine, University of Rostock, Rostock, Germany
| | - Roland Buhl
- Pulmonary Department, Mainz University Hospital, Mainz, Germany
| | - Stephanie Korn
- IKF Pneumologie Mainz, Mainz, Germany; Thoraxklinik Heidelberg, Heidelberg, Germany
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5
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Pérez-de-Llano L, Veiga-Teijeiro I, Dacal-Rivas D. Contribution of the Remission Concept to the Treatment of Asthma. Arch Bronconeumol 2023; 59:550-551. [PMID: 37005151 DOI: 10.1016/j.arbres.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Luis Pérez-de-Llano
- Pneumology Service, Lucus Augusti University Hospital. EOXI Lugo, Cervo e Monforte, Lugo, Spain.
| | - Iria Veiga-Teijeiro
- Pneumology Service, Lucus Augusti University Hospital. EOXI Lugo, Cervo e Monforte, Lugo, Spain
| | - David Dacal-Rivas
- Pneumology Service, Lucus Augusti University Hospital. EOXI Lugo, Cervo e Monforte, Lugo, Spain
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6
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Pérez de Llano L, Marina Malanda N, Urrutia I, Martínez-Moragón E, Gullón-Blanco JA, Díaz-Campos R, Esquerre MM, Mena AH, Cosío BG, Cisneros C, Polo FJL, Laorden D, Dacal Rivas D. Factors associated with suboptimal response to monoclonal antibodies in severe asthma. Allergy 2023; 78:2305-2310. [PMID: 36866939 DOI: 10.1111/all.15693] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 02/22/2023] [Accepted: 02/25/2023] [Indexed: 03/04/2023]
Affiliation(s)
- Luis Pérez de Llano
- Pneumology Service, Lucus Augusti University Hospital, EOXI Lugo, Cervo e Monforte, Lugo, Spain
| | | | - Isabel Urrutia
- Pneumology Service, Galdakao-Usansolo University Hospital, Galdakao, Spain
| | | | | | - Rocío Díaz-Campos
- Pneumology Service, Doce de Octubre University Hospital, Madrid, Spain
| | - Mariana Muñoz Esquerre
- Pneumology Service, Bellvitge University Hospital, IBIDELL, Barcelona University, Barcelona, Spain
| | - Alicia Habernau Mena
- Allergy Section, Internal Medicine Service, Complejo Hospitalario de Mérida, Badajoz, Spain
| | - Borja G Cosío
- Pneumology Service, Son Espases University Hospital, IdISBa-Ciberes, Palma de Mallorca, Spain
| | | | | | - Daniel Laorden
- Pneumology Service, La Paz University Hospital, Madrid, Spain
| | - David Dacal Rivas
- Pneumology Service, Lucus Augusti University Hospital, EOXI Lugo, Cervo e Monforte, Lugo, Spain
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7
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Tota M, Łacwik J, Laska J, Sędek Ł, Gomułka K. The Role of Eosinophil-Derived Neurotoxin and Vascular Endothelial Growth Factor in the Pathogenesis of Eosinophilic Asthma. Cells 2023; 12:cells12091326. [PMID: 37174726 PMCID: PMC10177218 DOI: 10.3390/cells12091326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/23/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
Asthma is a chronic complex pulmonary disease characterized by airway inflammation, remodeling, and hyperresponsiveness. Vascular endothelial growth factor (VEGF) and eosinophil-derived neurotoxin (EDN) are two significant mediators involved in the pathophysiology of asthma. In asthma, VEGF and EDN levels are elevated and correlate with disease severity and airway hyperresponsiveness. Diversity in VEGF polymorphisms results in the variability of responses to glucocorticosteroids and leukotriene antagonist treatment. Targeting VEGF and eosinophils is a promising therapeutic approach for asthma. We identified lichochalcone A, bevacizumab, azithromycin (AZT), vitamin D, diosmetin, epigallocatechin gallate, IGFBP-3, Neovastat (AE-941), endostatin, PEDF, and melatonin as putative add-on drugs in asthma with anti-VEGF properties. Further studies and clinical trials are needed to evaluate the efficacy of those drugs. AZT reduces the exacerbation rate and may be considered in adults with persistent symptomatic asthma. However, the long-term effects of AZT on community microbial resistance require further investigation. Vitamin D supplementation may enhance corticosteroid responsiveness. Herein, anti-eosinophil drugs are reviewed. Among them are, e.g., anti-IL-5 (mepolizumab, reslizumab, and benralizumab), anti-IL-13 (lebrikizumab and tralokinumab), anti-IL-4 and anti-IL-13 (dupilumab), and anti-IgE (omalizumab) drugs. EDN over peripheral blood eosinophil count is recommended to monitor the asthma control status and to assess the efficacy of anti-IL-5 therapy in asthma.
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Affiliation(s)
- Maciej Tota
- Student Scientific Group of Adult Allergology, Clinical Department of Internal Medicine, Pneumology and Allergology, Wroclaw Medical University, 50-369 Wrocław, Poland
| | - Julia Łacwik
- Student Scientific Group of Microbiology and Immunology, Department of Microbiology and Immunology, Zabrze, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
| | - Julia Laska
- Student Scientific Group of Microbiology and Immunology, Department of Microbiology and Immunology, Zabrze, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
| | - Łukasz Sędek
- Department of Microbiology and Immunology, Zabrze, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
| | - Krzysztof Gomułka
- Clinical Department of Internal Medicine, Pneumology and Allergology, Wroclaw Medical University, 50-369 Wrocław, Poland
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8
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Walsh GM. Recent developments in the use of monoclonal antibodies targeting the type 2 cytokines for severe asthma treatment. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2023; 98:31-54. [PMID: 37524491 DOI: 10.1016/bs.apha.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Severe or refractory asthma is seen in approximately 5% of asthmatic subjects who have unsatisfactory symptom control despite adherence to high-dose inhaled glucocorticoid therapies resulting in significant morbidity, reduced quality of life with attendant implications for healthcare costs. Marked heterogeneity in symptoms and at the molecular phenotypic level are hallmarks of asthma resulting in the requirement of specifically targeted treatments to block the key pathways of the disease. Monoclonal antibody (mAb)-based biologics targeted at inhibition of the type 2 cytokines IL-4, IL-5 and IL-13 have become established as effective treatments for severe asthma, with significant clinical benefit seen in carefully selected patient populations that take asthma phenotypes and endotypes into account. The further development of reproducible and straightforward discriminatory biomarkers may aid identification of those patients most likely to benefit from treatment with these interventions.
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Affiliation(s)
- Garry M Walsh
- Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, United Kingdom.
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9
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Laorden D, Zamarrón E, Romero D, Domínguez-Ortega J, Villamañán E, Losantos I, Gayá F, Quirce S, Álvarez-Sala R. Evaluation of FEOS score and super-responder criteria in a real-life cohort treated with anti-IL5/IL5R. Respir Med 2023; 211:107216. [PMID: 36958514 DOI: 10.1016/j.rmed.2023.107216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/25/2023]
Affiliation(s)
- Daniel Laorden
- Department of Pneumology, Hospital La Paz, Universidad Autónoma de Madrid, IdiPAZ, and CIBER of Respiratory Diseases, Madrid, Spain.
| | - Ester Zamarrón
- Department of Pneumology, Hospital La Paz, Universidad Autónoma de Madrid, IdiPAZ, and CIBER of Respiratory Diseases, Madrid, Spain
| | - David Romero
- Department of Pneumology, Hospital La Paz, Universidad Autónoma de Madrid, IdiPAZ, and CIBER of Respiratory Diseases, Madrid, Spain
| | - Javier Domínguez-Ortega
- Department of Allergy, Hospital La Paz, IdiPAZ, and CIBER of Respiratory Diseases, Madrid, Spain
| | | | | | - Francisco Gayá
- Department of Biostatistics, Hospital La Paz, Madrid, Spain
| | - Santiago Quirce
- Department of Allergy, Hospital La Paz, IdiPAZ, and CIBER of Respiratory Diseases, Madrid, Spain
| | - Rodolfo Álvarez-Sala
- Department of Pneumology, Hospital La Paz, Universidad Autónoma de Madrid, IdiPAZ, and CIBER of Respiratory Diseases, Madrid, Spain
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10
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Thelen JC, van Zelst CM, van Brummelen SE, Rauh S, In 't Veen JCCM, Kappen JH, Braunstahl GJ. Efficacy and safety of dupilumab as add-on therapy for patients with severe asthma: A real-world Dutch cohort study. Respir Med 2023; 206:107058. [PMID: 36462399 DOI: 10.1016/j.rmed.2022.107058] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/17/2022] [Accepted: 11/19/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dupilumab as add-on treatment for severe uncontrolled asthma (SA) has shown to be effective and safe by phase-III-trials. Real-world data on clinical efficacy and safety is limited. OBJECTIVE We aim to investigate the efficacy and safety of dupilumab as add-on therapy for SA in a real-world cohort. MATERIAL AND METHODS The primary endpoint was annually exacerbation-rate (AER). Secondary outcomes were maintenance oral corticosteroid (mOCS) dependency, asthma control (ACQ-5), pulmonary function (FEV1), quality of life (AQLQ) and frequency of reported adverse events (AEs). RESULTS Overall, 148 patients were included. Median AER [IQR] reduced from 4.00 [2.00-5.00] at baseline to 1.00 [0.00-2.00] at 12 months (p < 0.001). mOCS-dependency reduced from 39.9% of the patients at baseline, to 20.3% at 6 months and to 14.9% at 12 months (p < 0.001). Median ACQ improved from 3.00 [2.00-3.80] at baseline to 1.80 [0.60-2.95] after 6 months and to 1.40 [0.20-2.60] after 12 months (p < 0.001). Median FEV1 (L) improved from 2.21 [1.58-2.85] to 2.50 [2.00-3.06] at 6 months and to 2.51 [1.88-3.04] after 12 months (p < 0.001). The outcomes improved most in subgroups with high eosinophils (≥300/μL) or FeNO (≥50 ppb) at baseline. AEs were reported by 45.3% (67/148), of which headache was most frequent. CONCLUSIONS This study indicates that dupilumab as add-on therapy for SA is associated with significant improvements in exacerbation-rate, mOCS-dependency, asthma control, pulmonary function, and quality of life. These results are in line with those of previous phase-III-trials.
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Affiliation(s)
- John C Thelen
- Department of Pulmonology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.
| | - Cathelijne M van Zelst
- Department of Pulmonology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Pulmonary Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | | | - Simone Rauh
- Department of Science, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | | | - Jasper H Kappen
- Department of Pulmonology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Gert-Jan Braunstahl
- Department of Pulmonology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Pulmonary Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
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11
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Menzella F, Ballarin A, Sartor M, Floriani AF, Corsi L, Dartora C, Tonin S, Romagnoli M. Comparison between clinical trials and real-world evidence studies on biologics for severe asthma. J Int Med Res 2022; 50:3000605221133689. [PMID: 36420737 PMCID: PMC9703569 DOI: 10.1177/03000605221133689] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/30/2022] [Indexed: 12/30/2023] Open
Abstract
In recent years, the more widespread availability of biological drugs with specific mechanisms of action has led to significant breakthroughs in the management of severe asthma. Over time, numerous randomised clinical trials have been conducted to evaluate the efficacy and safety of these biologics and define the eligibility criteria of patients suitable for various therapeutic options. These studies were conducted under controlled conditions not always applicable to real life. For this and other reasons, real-world evidence and pragmatic studies are required to provide useful information on the effectiveness of biological drugs and their safety, even in the long term. Because differences in outcomes have sometimes emerged between clinical trials and real-life studies, it is important to clarify the causes of these discrepancies and define the significance of the results of studies conducted in the course of daily clinical practice. Thus, a scientific debate is ongoing, and no consensus has been reached. The purpose of this narrative review is to analyse the differences between randomised trials and real-world evidence studies, focusing on their roles in guiding clinicians among different therapeutic options and understanding the reasons for the large discrepancies often found in the results obtained.
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Affiliation(s)
| | - Andrea Ballarin
- Pulmonology Unit, S. Valentino Hospital, AULSS2 Marca Trevigiana, Italy
| | - Maria Sartor
- Pulmonology Unit, S. Valentino Hospital, AULSS2 Marca Trevigiana, Italy
| | | | - Lorenzo Corsi
- Pulmonology Unit, S. Valentino Hospital, AULSS2 Marca Trevigiana, Italy
| | - Cristina Dartora
- Pulmonology Unit, S. Valentino Hospital, AULSS2 Marca Trevigiana, Italy
| | - Silvia Tonin
- Pulmonology Unit, S. Valentino Hospital, AULSS2 Marca Trevigiana, Italy
| | - Micaela Romagnoli
- Pulmonology Unit, Cà Foncello Hospital, AULSS2 Marca Trevigiana, Italy
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12
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Specific Therapy for T2 Asthma. J Pers Med 2022; 12:jpm12040593. [PMID: 35455709 PMCID: PMC9031027 DOI: 10.3390/jpm12040593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/28/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022] Open
Abstract
Asthma is a disease with high incidence and prevalence, and its severe form accounts for approximately 10% of asthmatics. Over the last decade, the increasing knowledge of the mechanisms underlying the disease allowed the development of biological drugs capable of sufficiently controlling symptoms and reducing the use of systemic steroids. The best-known mechanisms are those pertaining to type 2 inflammation, for which drugs were developed and studied. Those biological treatments affect crucial points of bronchial inflammation. Among the mechanisms explored, there were IgE (Omalizumab), interleukin 5 (Mepolizumab and Reslizumab), interleukin 5 receptor alpha (Benralizumab) and interleukin 4/13 receptor (Dupilumab). Under investigation and expected to be soon commercialized is the monoclonal antibody blocking the thymic stromal lymphopoietin (Tezepelumab). Seemingly under study and promising, are anti-interleukin-33 (itepekimab) and anti-suppressor of tumorigenicity-2 (astegolimab). With this study, we want to provide an overview of these drugs, paying particular attention to their mechanism of action, the main endpoints reached in clinical trials, the main results obtained in real life and some unclear points regarding their usage.
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